Need Assessment

Needs Assessment

I. OVERVIEW

General Comments
- This Analysis step of ADDIE will examine a specific job task- Case Conceptualization- that is to be performed by Case Managers in the Residential Program of White’s Residential & Family Services. This issue presents both a challenge and opportunity as it is an issue that has bothered me since I assumed the position of Director of Training (among other things). A former staff member’s stinging statement to me has stuck with me and provides a sharp prod to correct this situation. The statement was “They (Case Managers) seem to think a student was born the day they were admitted and die the day they leave."
Strategic importance of what was analyzed
- I believe this is a critical skill that has enormous long-term consequences both for the students in our Residential Program and for the Case Managers who work with them.
Purpose and goals of analysis
- To determine if there is a performance “gap"
- If there is such a “gap,” determine the cause(s):
  - Training needs (don’t know how)
  - Job performance need- motivation (know how but don't do)
  - Systems problem – resource environment (organizational hindrance)
  - Selection (not the right person for the job)
  - Some combination of above

II. DATA COLLECTION

Methods used
- Mostly “informal” as there are no present instruments to measure this job task.
Constraints (decisions made on what to do and what not to do)
- Difficult and time consuming to design, conduct and analyze a full blown data collection.
- At this point I have decided go on personal experience and the informal data that has been collected.
Instruments used
- The informal ones listed below.

III. SOURCES OF DATA

Human sources
- My many years of personal experience as a supervisor.
  - I have supervised Case Managers for many years and have seen some who do this very well.
  - I having done some of this training in the past in a different program of the agency and have seen positive results.
- Conversations with Case Managers
  - Have heard them make comments like: “Not sure what our job is," and “Don’t know what we are supposed to do with this student."
- Feedback from other parts of “system"
  - Clinical Staff: “Case Managers don’t know their students."
  - School Staff: “They don’t seem to know what is going on beyond campus."
- Anecdotal information
  - Several recent cases where inadequate preparation was made for students’ discharge from our program.
Data sources (reports, procedures, etc.)
- Reading Individual Treatment Plans and noticing not very “individual” and little sense of where this case is going and steps to get there.
- Review of undergrad degrees (generally only BSW programs provide this training and hold it as a value.)
Customer sources
- Outcome Measures Placing Agency Worker Surveys
  - Often lower (relatively, still very high) ratings around planning and communication which reflect somewhat on the quality of information as well as the level of communication between Case Managers and placing agencies (our “customers").

IV. CONCLUSIONS

Performance standards (Needs of the organization)
- Basic Job Duties
  - Ownership and management of cases
  - Five Major Functions of Case Management
    - Assessment
    - Planning
    - Implementation
    - Coordination
    - Monitoring & Reassessment
- Task(s) (Required performance)
  - Note that there are many other sub-tasks included in Case Management and other tasks required for successful execution of the Case Manager’s job not listed above. This analysis focuses on one major area of performance that seems to be weak somewhat “across the board” and is foundational to much of what a Case Manager does- Case Conceptualization.
  - “Case Managers will conceptualize (i.e. develop a vision of) the cases assigned to them in a timely and accurate manner."
    - Tasks steps are:
      - Gather information about a student from as many sources as possible.
      - Thoroughly review the information.
      - Analyze the information, noting patterns, connections, causes and effects, needs and issues.
      - Form a “conceptualization” of the case that is:
        
        Comprehensive (all areas/domains, present and future)
        
        Balanced (strengths and weaknesses)
Performance deficiencies (Needs of organization minus performance level= gap)
- Feedback from various sources indicate that performance in this area of Case Management tends to be weak overall and very inconsistent among individual Case Managers.
- Areas of weakness include:
  - Tendency to see students as homogeneous.
  - Tendency to focus on the “here and now” and fail to adequately plan interventions to help student prepare for “life after White’s.”
  - Little assessment of and work with persons and systems that student will interact with when they leave White’s (caretakers, school, community resources, etc.)
  - Communicate an unbalanced view of students with almost entire focus on weaknesses.
Causes of deficiencies
- Affect/values (“Soft skills”)
  - “Not my job” (Directly and indirectly Case Managers have made this statement.)
    - This is an organizational problem.
      - There has been a transition in philosophy, programming and job expectations, i.e. a “new paradigm.’’
      - Supervisors haven’t been clear and consistent communicating what the job is. (And there is some disagreement as to what the “new paradigm” really is.)
      - Case Managers are required to do many other duties left over from the “old paradigm” (crisis management, transporting, etc.) and lack quality time to complete this task.
    - This part of the problem is primarily a systems problem and will need interventions beyond instruction/training. (See "non-training recommendation" at the end of this document.)
    - This is also clearly a training problem. We haven’t provided clear instruction/training specifically stating that this is a major aspect of “the new paradigm” of what a Case Manager does. Instruction/training can address this issue.
    - There is also a worker selection problem. We have hired those who do not vision their job this way and some for whom this is not a natural skill area.Instruction/training will not fill this need.
  - Lack of confidence (Some see this as beyond their ability.)
    - * Quality instruction/training can increase the probability that the Case Managers can indeed be successful in this job task.
- Cognitive
  - Many Case Managers lack the knowledge and skills necessary to complete this job task in a quality manner.
    - * The knowledge and skills necessary for successful completion of this job task have a high probability to be developed through quality instruction/training.
Consequences of deficiencies
- Timely and accurate case conceptualization by the Case Manager is essential to providing quality care for students in the White’s Residential Program. The following are some of the consequences of deficiencies on this job task:
  - Students do not get individualized care.
  - Case Managers are not able to accurately communicate to other “players” in the system the strengths and needs of individual students.
  - There is inefficient use of resources (program interventions) because there is not clear direction regarding the needs of individual students.
  - Because of inadequate case conceptualization little prioritization of needs is made.
  - Students leave without adequate preparation for “life after White’s.”

V. RECOMMENDATIONS

Training recommendations
- Non-training recommendations
  - Rationale
    - Obviously there are numerous system issues as listed above. These need to be addressed via methods other than instruction/training.
  - Description
    - Re-writing of Case Manager Job Description.
    - Full Supervisor buy-in to “new paradigm.”
    - Reorganization and prioritization of Case Manager duties.
  - Audience
    - Supervisors of Case Managers.
    - Residential Director.
  - Benefits
    - Increase probability that instruction/training would be successful and the benefits to students and Case Managers listed above would be realized.
  - Anticipated problems
    - Some of the Supervisors have not completely embraced the “new paradigm” and may not fully support this instruction/training.
    - To completely free Case Mangers to be trained in a quality manner and to be free to focus on this job task will require additional personnel. This is not likely to happen in our current financial situation.
- Other recommendations and commentary
  - It appears that instruction/training does indeed have a high probability of improving the performance of Case Managers and should be pursued. Obviously there are system issues that affect instruction/training that are mostly beyond the control of the instructor/trainer. But the instruction/training must go on.
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